Tanguy I. Seiwert, MD, assistant professor of Medicine, University of Chicago Medicine, discusses managing toxicities associated with immunotherapy for patients with head and neck cancer.

This is an exciting time to be a medical oncologist because the field is changing so rapidly, Seiwert explains. It is very important for physicians to get comfortable with immunotherapy and the side effect profiles. Moreover, he says, side effects can also be a sign of efficacy. Even the more severe adverse events, as frequently seen with CTLA-4 inhibitors, are also manageable.

It is important for community-based physicians to get more experience administering these immunotherapy agents, just as they have with various other treatments in the past, Seiwert concludes.

Videos

Dr. Seiwert on Managing Side Effects for Head and Neck Cancer Treatment

Tanguy I. Seiwert, MD, assistant professor of Medicine, University of Chicago Medicine, gives advice to community oncologists on administering immunotherapy to patients with head and neck cancer.

In general, these PD-1 agents are well tolerated. It is reasonable to start using them in patients earlier in the disease course as they have a survival benefit, Seiwert explains. Moreover, he adds, it is important to provide access to these treatments broadly across the country.

Simultaneously, there is also a significant unmet need for this patient population. This is because many patients will progress on PD-1 therapy, and Seiwert encourages patients to go on a clinical trial or back to chemotherapy; however, he adds, chemotherapy is not an ideal choice.

Dr. Seiwert on Advice With Immunotherapy for Head and Neck Cancer

Tanguy I. Seiwert, MD, assistant professor of Medicine, University of Chicago Medicine, discusses ongoing clinical trials in the field of head and neck cancer.

Seiwert goes into detail with the phase I/II findings of the combination of lirilumab plus the PD-1 inhibitor nivolumab (Opdivo) in patients with squamous cell carcinoma of the head and neck (SCCHN), which led to an objective response rate (ORR) of 24.1%.

In the CheckMate-651 study, the CTLA-4 inhibitor ipilimumab (Yervoy) and nivolumab are being explored together, a combination that has demonstrated efficacy in other solid tumors. There are studies investigating immunotherapy and chemotherapy, as well, he adds.

Dr. Seiwert on Ongoing Trials in Head and Neck Cancer

Tanguy I. Seiwert, MD, assistant professor of Medicine, University of Chicago Medicine, discusses the next steps researchers are taking to improve survival outcomes for patients with head and neck cancer.

While there are the 2 FDA approvals of the PD-1 inhibitors pembrolizumab (Keytruda) and nivolumab (Opdivo) for these patients, there is still much more work to be done. Moreover, he adds, researchers are just scratching the surface as responses rates are only seen in 13% to 20% of patients.

However, there is greater potential for more of a benefit. This includes combinations of these PD-1 inhibitors with chemotherapy or other immunotherapies, he adds.

Dr. Seiwert on Next Steps in Treatment of Patients With Head and Neck Cancer

Tanguy Y. Seiwert, MD, assistant professor of Medicine, University of Chicago Medicine, discusses the current prognosis for patients with head and neck cancer prior to the FDA approvals of immunotherapy agents nivolumab (Opdivo) and pembrolizumab (Keytruda) as treatments.

Head and neck cancer is generally curable; however, once it becomes recurrent or metastatic, the prognosis becomes very poor, Seiwert explains. Available treatments such as cetuximab (Erbitux) and chemotherapy regimens do not typically lead to survival benefits for patients. The field appeared to be very dismal, he says, until the approvals of the PD-1 inhibitors. These agents have a response rate of 13% to 20%, but they have a major impact on overall survival (OS). Currently, the 1-year OS rate with these agents is approximately 40%, which is unreached with other treatments.

These agents influence OS in a very significant way, while progression-free survival and response rate are not good markers of benefit, he adds.

Tanguy I. Seiwert, MD

Articles

Dr. Seiwert on Managing Side Effects for Head and Neck Cancer Treatment

Dr. Seiwert on Advice With Immunotherapy for Head and Neck Cancer

Dr. Seiwert on Ongoing Trials in Head and Neck Cancer

Dr. Seiwert on Next Steps in Treatment of Patients With Head and Neck Cancer

Dr. Seiwert on Prognosis for Patients With Head and Neck Cancer